Individual
DANIEL ELMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 336-0985
Mailing address
2537 W STATE ST STE 200, BOISE, ID 83702-2200
(208) 336-0985
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
45355
ID
Other
Enumeration date
12/09/2019
Last updated
12/09/2019
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